Low-dose cimetidine in the acute treatment of duodenal ulcer. Comparison of a single nocturnal dose regimen with a twice daily regimen

Efficacy and safety of proton pump inhibitors and H2 receptor antagonists in the initial non‑eradication treatment of duodenal ulcer: A network meta‑analysis

The present network meta-analysis aimed to enhance the corresponding evidence with respect to the efficacy and safety of pharmaceuticals treatments. Frequentist network meta-analysis was used. Medical literature up to November 2022 was searched for randomized clinical trials assessing the efficacy and safety of these pharmaceuticals, either compared with each other or compared with placebo. With the exception of ranitidine (300 mg four times daily) and vonoprazan (20 mg once daily) having lower safety than placebo, the efficacy and safety of the remaining treatments were superior to placebo. Cimetidine (400 mg four times daily) and pantoprazole (40 mg once daily) were ranked first in terms of efficacy. The frequentist network meta-analysis shows that for cimetidine (except 400 mg once daily), famotidine, rabeprazole, ilaprazole, lansoprazole (except 7.5 mg once daily) and omeprazole (except 10 mg once daily or 30 mg once daily), the efficacy comparison between the different doses of each of the aforementioned pharmaceuticals did not indicate statistically significant differences. In conclusion, pantoprazole (40 mg once daily) was the best choice for the initial non-eradication treatment of patients with duodenal ulcer, and cimetidine (400 mg twice daily), omeprazole (20 mg once daily), lansoprazole (15 mg once daily), ilaprazole (5 mg once daily) and rabeprazole (10 mg once daily) could be used as the first choice. If the aforementioned pharmaceuticals cannot be prescribed, famotidine (40 mg twice daily) is recommended.

A single standard nocturnal dose of nizatidine enhances the healing of active duodenal ulcers among Chinese

Chinese people have a lower maximal acid output and gastrin response to meals compared to Western people. The aim of the present study was to assess the efficacy of a half-single nocturnal dose of nizatidine (150 mg at bedtime [h.s.], n = 40) with a standard full dose given once nightly (300 mg h.s., n = 38) or twice daily (150 mg twice a day [b.i.d.], n = 43) in the treatment of Chinese patients with active duodenal ulcers. An endoscopy was performed upon entry and at 4 week intervals until the ulcer healed (up to 8 weeks). There is no statistical difference in healing rates after 4 weeks of treatment (52.5, 52 and 47% in nizatidine 150 mg h.s., 150 mg b.i.d. and nizatidine 300 mg h.s., respectively) whereas nizatidine 300 h.s. had a significantly higher healing rate compared to nizatidine 150 mg h.s. and b.i.d. after 8 weeks of treatment (89 vs 70 and 67%, P < 0.05) by uni- and multivariate analysis of clinical and endoscopic characteristics. Symptomatic response was not significantly different in these three treated groups. Our study suggested that a half-single nocturnal dose of nizatidine is not ideal for the treatment of duodenal ulcer in Chinese patients, whereas a single standard nocturnal dose appears more effective than a twice-daily regimen.